All systems go: An ecological perspective of behavioral health for youth with type 1 diabetes

David V. Wagner, Natalie Koskela-Staples, Michael Harris, Samantha A. Barry

Research output: Contribution to journalArticle

Abstract

Introduction: Youth with type 1 diabetes (T1D) experiencing self-management difficulties are at risk of irreversible long-term health problems and consume a disproportionate amount of health care resources. Behavioral health interventions for this population have shown limited long-term effects, perhaps because of limited research on and intervention in relevant environments. To effectively intervene, providers must first thoroughly understand how risk factors interact with various contexts (e.g., school, home, hospital) to determine opportunities for the development of relevant interventions. Method: This review utilized an ecological systems framework to examine the state of the literature with regard to risk factors for poor T1D outcomes and associated intervention. Results: This review identified that, whereas risk factors in some systems (e.g., individual, family) have received disproportionate scrutiny, other environments and contexts (e.g., school, medical system) have been relatively neglected by researchers. Similarly, interventions that target understudied environments are lacking, and the majority of rigorously studied interventions only target a single context. Perhaps this accounts for the lack of interventions shown to have a long-term impact on glycemic control. Discussion: Our review demonstrates that researchers and funding agencies should prioritize efforts that (a) examine the influence of underexamined environments (e.g., primary care clinics, schools) and interactions (e.g., health care provider to parent, school nurse to youth) on T1D outcomes, (b) place increased emphasis on inclusion of understudied populations (e.g., families of minority racial/ethnic backgrounds), and (c) develop and evaluate interventions that specifically are tailored for these settings, interactions, and populations.

Original languageEnglish (US)
Pages (from-to)10-29
Number of pages20
JournalFamilies, Systems and Health
Volume37
Issue number1
DOIs
StatePublished - Mar 1 2019

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Type 1 Diabetes Mellitus
Health
Research Personnel
Population
Health Resources
Self Care
Medical Schools
Health Personnel
Ecosystem
Primary Health Care
Nurses
Delivery of Health Care
Research

Keywords

  • Pediatric
  • Risk
  • System
  • Treatment
  • Type 1 diabetes

ASJC Scopus subject areas

  • Applied Psychology
  • Psychiatry and Mental health

Cite this

All systems go : An ecological perspective of behavioral health for youth with type 1 diabetes. / Wagner, David V.; Koskela-Staples, Natalie; Harris, Michael; Barry, Samantha A.

In: Families, Systems and Health, Vol. 37, No. 1, 01.03.2019, p. 10-29.

Research output: Contribution to journalArticle

Wagner, David V. ; Koskela-Staples, Natalie ; Harris, Michael ; Barry, Samantha A. / All systems go : An ecological perspective of behavioral health for youth with type 1 diabetes. In: Families, Systems and Health. 2019 ; Vol. 37, No. 1. pp. 10-29.
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